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Tremors


A tremor is an involuntary body movement that is characterized by rhythmic to-and-fro shaking motions of one or several parts of a person’s body. It is typically seen in the hands, but can occur in the face, vocal cords, trunk, arms and legs. These oscillating movements commonly afflict middle-aged or older adults, although they can strike men and women of all ages. The existence of a tremor sometimes signals the presence of a neurological disorder.

Tremors can occur infrequently, or they can come about erratically in brief episodes. While there are medications and other treatments available to minimize the incidence of tumors and help sufferers alleviate this physical hindrance, not many of them seek medical attention for their condition.

TREMORS SYMPTOMS

The symptoms of most tremors include trembling of the hands, arms, head, legs and trunk; a quivering voice, difficulty in holding or handling items such as utensils or pencils, and having to constantly struggle to write or draw properly. When the sufferer becomes highly emotional, fatigued, or is subject to stress, it can bring about an attack of tremors. In some instances, specific motions or body postures can trigger them.

There are around 20 different kinds of tremors and the most common is called the essential tremor (ET). Essential tremor, or familial tremor, is a type of resting tremor that exhibits symptoms of stiffness and slow movement. It is generally harmless and can be genetically inherited. They arise in 5% of middle-aged adults from the age of 40, and in 20% of people over the age of 65. In the United States, approximately 10 million people suffer from essential tremors.

Essential tremors are usually mild and non-aggressive, however, some people afflicted with ET will experience an eventual progression of this tremor, beginning with a single side and within the course of a couple of years, affecting both sides of the body. Other symptoms of essential tremor include head quivering and an uneven gait. While the occurrence of the trembling may decrease with age, its severity can worsen, eventually hampering a person’s day-to-day activities. This type of is usually be triggered by emotional or physical stress, fever, fatigue or hypoglycemia (low blood sugar).

TREMORS CAUSES

Another common type of tremor is that caused by Parkinson’s disease, or Parkinsonian tremor. This kind of resting tremor is caused by impairment of areas of the brain responsible for controlling movement. In 25% of persons afflicted with Parkinsonian tremor, it is usually a signal of the onset of Parkinson’s disease. Symptoms usually appear after a person reaches the age of 60, and is characterized by a “pill-rolling” motion of the hands, chin, lips, trunk and legs.

Other types of tremors include Dystonic tremor, a symptom of the movement disorder, Dystonia which is exhibited by uncontrollable contractions of the muscles, constant twisting, and painful and aberrant body postures; Cerebellar tremor, an unconsciously rough movement of the extremities that occurs after a conscious motion. This is caused by lesions that have developed in the cerebellum following a stroke, multiple sclerosis, cancer, and alcohol or substance abuse; Psychogenic tremor which occurs when a body is at rest; Orthostatic tremor which exhibits rapid and rhythmic contractions and cramping of the leg and trunk muscles when the afflicted person stands up; Rubral tremor, a slow type of tremor usually associated with strokes, and Psysiologic tremor which affects everyone and is seldom visible. This type of tremor is the body’s reaction to fatigue, emotional stress, low blood sugar, hyperthyroidism, fever, alcohol or narcotics withdrawal, caffeine, or other stimulants.
Tremors
Image: Tremors


Tremors may also occur due to neurological disturbances that affect the spinal cord and brain, particularly in areas that are responsible for movement control. Some of these nervous system disorders include stroke, brain trauma, multiple sclerosis, and degenerative diseases of the brain which injure or impair the cerebellum. Some tumors may also be caused by the body’s reaction to substances such as amphetamines, corticosteroids, Vitamin B1 deficiency, the bite of the Australian redback spider, advanced liver disease, or mercury poisoning.

Other causes of tremors include alcohol addiction tremors (Asterixis), and Peripheral neuropathy which is the result of trauma to the muscles stemming from disease, injury, nervous system abnormalities, or other chronic conditions.

Tremors are generally worsened by physical or emotional stress, fatigue, alcohol or narcotics withdrawal, caffeine, hyperthyroidism, and certain medications used to treat asthma such as Ventolin, and other drugs like corticosteroids, theophylline (Bronkodyl, Theolair), and anticonvulsants like valproate (Deparene).

TREMORS COMPLICATIONS

Tremor complications include difficulty accomplishing day-to-day tasks, particularly those involving the use of fine motor skills like writing. Speech may also be affected (Dysarthria) and so will balance, and cognitive skills (vision and learning).

People who have a family history of tremors have a higher risk, as much as a 50% chance, or acquiring them. Age is also a risk factor, as tremors affect adults who have reached middle-age or older.

TREMORS DIAGNOSIS

Diagnosing which type of tremors a person has will involve the doctor checking whether they occur during motion or when the person is at rest. Other factors the doctor will consider are the existence of sensory impairment, muscle weakness or degeneration, and a decline of reflexes. The doctor will also take down a patient’s family history to determine any genetic predisposition towards tremors. Other diagnostic tests include blood and urine tests to check for thyroid, metabolic or chemical deficiencies, and the patient’s reaction to alcohol, certain medications and other substances, as well as to rule out the existence of other conditions.

The doctor may also order a CT scan or an MRI if a brain or nervous system disorder is suspected. There will likewise be other neurological tests to check the condition of a patient’s nerves, as well as sensory and motor skills. A type of test called an electromyogram is designed to detect muscle activity and the nerves’ response to stimuli in order to determine the presence of any muscular or nervous disorder.

TREMORS TREATMENT

Generally, there is no cure for tremors. However, incidence of tremors can be reduced only by treating the underlying conditions that cause them. Parkinsonian tremors may be treated using Levodopa, amantadine hydrochloride, anticholinergic drugs, or dopamine-like medications such as pergolide mesylate or bromocriptine mesylate.

Propranolol, beta-blockers and anticonsulsants are effective for essential tremor, while patients affected by Rubral tremor respond well to Levodopa and anticholinergic medications. While there is no medical treatment for Cerebellar tremors, Valium and intramuscular injections of botulinum toxin can relieve Dystonic tremors. Beta-blockers can treat the symptoms of Enchanced physiologic tremors, and a Valium and promidone combination works well for Primary orthostatic tremors.

Physical therapy is also recommended to decrease tremor incidence, and enhance muscle control and movement coordination. To remedy severe essential tremors, a surgical procedure known as Thalamotomy will remove portions of the thalamus, a recessed part of the brain responsible for receiving sensory input. This risky operation is a final option for tremors which do not respond to drug treatment. Another treatment known as Deep Brain Stimulation, or DBS, involves using implanted electrodes to impart high-frequency electric stimulation on the thalamus to halt and even reverse the tremors.

TREMORS PREVENTION

Tremor prevention is as simple as avoiding what triggers their occurrence. Patients are advised to stay away from caffeine and other similar stimulants, including minimizing their alcohol consumption. Coping skills like relaxation techniques can ward off stress which causes tremors. Adequate rest, exercising the body parts affected by the tremor and joining a support group may help a patient manage tremor symptoms better.

Tremors are not usually fatal, but they can cause embarrassment and greatly inconvenience a patient in the performance of day-to-day activities. While treatment can reduce symptoms, tremors, particularly essential tremors worsen over time and may cause debilitating impairment.

The National Institute of Neurological Disorders and Stroke of the Department of Health continues its research on tremors that affect the brain and nervous system. Other research is being undertaken by the non-profit International Essential Tremor Foundation, which aids patients and families of tremor sufferers in receiving appropriate diagnoses and treatment for tremor conditions.

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